Clinical Papers

Increasingly, patients are seeking minimally invasive methods to tighten skin and remodel adipose tissue. A large treatment gap exists among 3 types of patients: (1) the younger demographic, who increasingly desire soft tissue tightening without traditional operations, scars, and downtime; (2) patients with soft tissue laxity who are not “severe enough” to justify an excisional procedure, but not “mild enough” to rely on liposuction with soft tissue contraction alone; and (3) those with recurrent laxity who already underwent traditional excisional procedures. In these populations, plastic surgeons risk under- or overtreating with traditional methods. The purpose of this supplement is to describe the utility of radiofrequency (RF) microneedling (Fractora modified to Morpheus8 InMode Aesthetic Solutions, Lake Forest, CA) in combination with bipolar RF (FaceTite/BodyTite, InMode AestheticSolutions). By combining these procedures, the aforementioned treatment gap can be addressed. The RF microneedling allows for subdermal adipose remodeling and skin tightening. Addition of bipolar RF also tightens the skin by contraction of the underlaying fibroseptal network in addition to induction of neocollagenesis, elastogenesis, and angiogenesis at skin surface temperatures of 40° to 50°C. In our experience, these technologies have been effective and safe in these patient populations. DOWNLOAD PAPER

BodyTite® is a bipolar, radiofrequency assisted lipocoagulation (RFAL) systemand concept that helps the liposuction surgeon better control soft tissue contractionand the contours of the face, neck and body when performing aspiration lipoplasty,or skin tightening alone. There are several different BodyTite® hand pieces that are designed for different clinical procedures and body contouring applications. This chapter outlines the basic science of RFAL, the scientific evidence for contraction and efficacy, as well as, the authors 10-year experience using BodyTite® and RFAL hand pieces to deliver the best possible soft tissue contraction and body contouring. DOWNLOAD PAPER

Liposuction of the arms alone may be inadequate for aesthetic improvement because of skin laxity. Radiofrequency-assisted liposuction (RFAL) and aggressive superficial liposuction (SupL) have been described to stimulate soft tissue retraction to improve results. We compare the techniques and describe a classification scheme that factors skin laxity, skin quality, and Fitzpatrick type to provide treatment recommendations. DOWNLOAD PAPER

Dr Steve Mulholland takes us on the journey of minimally invasive and non-invasive energy based techniques to rejuvenate the aging neck. He frequently combines these techniques with open aggressive procedures. Realizing that minimally invasive techniques can provide measureable skin tightening has provided yet another opportunity to answer our patients’ desires for procedures with a quicker recovery. Of course these can be stand alone procedures or performed along with or following more aggressive surgical maneuvers. The patient with minimal submental and or jowl laxity after a face and necklift looks to us to provide a solution. For sure, we enjoy surgery more than our patients and therein lies their quest for an easy answer without surgical expense and downtime. DOWNLOAD PAPER

Recent publications show that heat-mediated tissue tightening is a promising treatment for the lax abdomen and may provide better long-term outcomes than traditional suction-assisted liposuction (SAL). The author evaluates the degree and duration of skin surface area contraction, as well as the influence of anatomic location of the treatment region on the degree of tissue tightening, in a study comparing SAL alone vs SAL plus radiofrequency-assisted liposuction (RFAL). DOWNLOAD PAPER

Radiofrequency-assisted liposuction is a relatively new concept in energy-assisted body contouring techniques and has received instrument approval. This supplemental article reviews the clinical application of electromagnetic energy via the BodyTite (InMode Corporation, Toronto, Canada) device on soft tissues during suction lipectomy, its effect on soft tissue contraction, and its use in aesthetic body contouring in various clinical scenarios. DOWNLOAD PAPER

From July to December of 2008, 23 subjects underwent radiofrequency-assisted liposuction using the BodyTite system. Information regarding aesthetic results and local and systemic complications was collected immediately after the procedure and at 6- and 12-week follow-up. The authors' study suggests that the removal of moderate volumes of fat with concurrent subdermal tissue contraction can be performed safely and effectively with radiofrequency-assisted liposuction. Additional benefits of this technique are excellent patient tolerance and fast recovery time. Nonetheless, a larger sample is required to confirm the authors' results and guarantee the efficacy and safety of the procedure. Direct comparison with traditional liposuction or energy-assisted liposuction techniques may provide some insights to tailor future indications of this novel technique. DOWNLOAD PAPER

Liposuction treats lipodystrophy and reduces the thickness of body contouring flaps. Patients are evaluated for suitability of deformity, skin quality, and understanding of the procedure. Inelastic and hanging skin is contraindicated for aesthetic lipoplasty. In general, a circumferential approach is taken to maximize skin shrinkage and harmonize the result. The traditional technique of suction-assisted lipectomy is presented with emphasis on smoothing and delivering the fat by the helping hand. Large volume liposuction requires attention to maintain normothermia, fluid balance, and deep vein thrombosis (DVT) prophylaxis. Of the special energy sources, power assisted, laser, and ultrasonic, the author prefers and elaborates on ultrasonic and radio-frequency usage. By reducing, undermining, and gentle fat removal, liposuction can safely and effectively be combined with extensive body contouring surgery. DOWNLOAD PAPER

A new liposuction technology for adipocyte lipolysis and uniform three-dimensional tissue heating and contraction is presented. The technology is based on bipolarradiofrequency energy applied to the subcutaneous adipose tissue and subdermal skin surface. Preliminary clinical results, thermal monitoring, and histologic biopsies of the treated tissue demonstrate rapid preaspiration liquefaction ofadipose tissue, coagulation of subcutaneous blood vessels, and uniform sustained heating of tissue. DOWNLOAD PAPER